Cardiac and arterial target organ damage in adults with elevated ambulatory and normal office blood pressure

Background: Ambulatory blood pressure may be higher or lower than clinic bl ood pressure. Attention has focused on "white coat hypertension" (normal am bulatory blood pressure elevated in the clinic). The converse phenomenon of high ambulatory blood pressure but normal office blood pressure-"white coa t normotension"-has not been studied. Objective: To assess whether white coat normotension (awake ambulatory bloo d pressure > 134/90 mm Hg and clinic blood pressure < 140/90 mm Hg) is asso ciated with target organ damage. Design: Cross-sectional observational study. Setting: University hospital hypertension center and participant work sites . Patients: 295 clinically normotensive adults and 64 patients with sustained hypertension (elevated clinic and ambulatory blood pressure). Measurements: Target organ abnormalities were measured by echocardiography and arterial ultrasonography in 61 patients with white coat normotension, 2 34 with sustained normotension (normal clinic and ambulatory blood pressure ), and 64 with sustained hypertension. Results: Patients with white coat normotension were older; had higher body mass indices, serum creatinine concentrations, and glucose levels; and a hi gher prevalence of current smokers. Left ventricular mass index and relativ e wall thickness were higher by 13 g/m(2) (Cl, 8 to18 g/m(2)) and by 0.03 ( Cl, 0.01 to 0.04), respectively, in patients with white coat normotension c ompared with those who had sustained normotension. Patients with white coat normotension and those with sustained hypertension did not differ signific antly for left ventricular mass index (4 g/m(2) [Cl, -3 to 10 g/m(2)) or re lative wall thickness (0.01 [Cl, -0.01 to 0.03]). The prevalence of discret e atherosclerotic plaques was similar in patients with white coat normotens ion (17 of 61, or 28% [Cl, 17% to 39%]) and those with sustained hypertensi on (17 of 64, or 27% [Cl, 16% to 38%]), but the difference lost significanc e after adjustment for age. Conclusions: White coat normotension is associated with left ventricular ma ss and carotid wall thickness similar to those in sustained hypertension. T he association of white coat normotension with prognostically important tar get organ damage may partly explain the ability of high normal left ventric ular mass and high normal clinic blood pressure to predict subsequent hyper tension and cardiovascular events in patients with clinical normotension.